title: Detecting mood disorder in resource-limited primary care settings: comparison of a self-administered screening tool to general practitioner assessment.
abstract: OBJECTIVE
  Although efficacious treatments for mood disorders are available in primary care, under-diagnosis is associated with under-treatment and poorer outcomes. This study compares the accuracy of self-administered screening tests with routine general practitioner (GP) assessment for detection of current mood disorder.
  
  
  METHODS
  197 consecutive patients attending primary care centres in Santiago, Chile enrolled in this cross-sectional study, filling out the Patients Health Questionnaire-9 (PHQ-9) for depression and the Mood Disorder Questionnaire (MDQ) for bipolar disorder, after routine GP assessment. Diagnostic accuracy of these self-administered tools was compared with GP assessment, with gold standard diagnosis established by a structured diagnostic interview with trained clinicians (SCID-I).
  
  
  RESULTS
  The sample was 75% female, with a mean age of 48.5 (SD 16.8); 37% had a current mood disorder (positive SCID-I result for depression or bipolar disorder). Sensitivity of the screening instruments (SI) was substantially higher than GP assessment (SI: 0.8, [95% CI 0.71, 0.81], versus GP: 0.2, [95% CI 0.12, 0.25]: p-value < 0.0001), without sacrifice in specificity (SI: 0.9, [95% CI 0.86, 0.96], versus GP: 0.9, [95% CI 0.88, 0.97]: p-value = 0.7). This led to improvement in both positive predictive value (SI: 0.8, [95% CI 0.82, 0.90], versus GP: 0.6, [95% CI 0.50, 0.64]: p-value < 0.001) and negative predictive value (SI: 0.9, [95% CI 0.78, 0.91] versus GP: 0.7, [95% CI 0.56, 0.72]: p-value < 0.01).
  
  
  CONCLUSIONS
  Self-administered screening tools are more accurate than GP assessment in detecting current mood disorder in low-income primary care. Such screening tests may improve detection of current mood disorder if implemented in primary care settings.
authors.affiliation: Hospital Clínico Universidad de Chile, Unidad de Trastornos del Ánimo, Clínica Psiquiátrica Universitaria. Facultad Medicina, Universidad de Chile, Santiago, Chile.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Vöhringer
authors.forename: Mirtha I
authors.initials: MI
authors.lastname: Jimenez
authors.forename: Mirko A
authors.initials: MA
authors.lastname: Igor
authors.forename: Gonzalo A
authors.initials: GA
authors.lastname: Fores
authors.forename: Matias O
authors.initials: MO
authors.lastname: Correa
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Sullivan
authors.forename: Niki S
authors.initials: NS
authors.lastname: Holtzman
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Whitham
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Barroilhet
authors.forename: Katherine
authors.initials: K
authors.lastname: Alvear
authors.forename: Tanya
authors.initials: T
authors.lastname: Logvinenko
authors.forename: David M
authors.initials: DM
authors.lastname: Kent
authors.forename: Nassir S
authors.initials: NS
authors.lastname: Ghaemi
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology; D002677:Chile / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis* / Q000453:epidemiology; D011203:Poverty; D011320:Primary Health Care; D011795:Surveys and Questionnaires
keywords: Bipolar Disorder; Depression; Mental health; Mood Disorders; Primary care; Screening